1. Field of the Invention
The present invention relates generally to surgical apparatus and methods and, more particularly, to a device and method for dispensing surgical packing through a narrow diameter trocar.
Conventional open surgical procedures often use absorptive packing material, referred to as laptape, to pack organs away from the operating field and to staunch blood flow in areas of profuse bleeding. Laptape is generally composed of a soft cotton fabric and comes in various sizes, including small squares of about 15 inches and narrow strips of about 3 inches by 15 inches.
The use of laptape for surgical packing in laparoscopic and other endoscopic procedures is problematic. Laparoscopy relies on the use of narrow diameter access tubes, usually referred to as trocars, to provide access to a working region created by insufflation (pressurization) of a patient's abdominal region. The trocars have proximal valves, to maintain pressurization, and a laparoscope as well as certain specialized surgical instruments are introduced through several trocars to perform a desired surgical procedure. The introduction of conventional laptape through the trocars, however, is difficult or impossible.
Thus, there exists a need to provide devices and methods to facilitate the introduction and positioning of surgical packing during laparoscopy and other endoscopic procedures. The methods should permit the packing to be conveniently and accurately introduced through the laparoscopic trocars as a part of the surgical procedure.
U.S. Pat. No. 5,074,840, to Yoon, recognizes the difficulty in introducing conventional surgical packing material in laparoscopic and other endoscopic procedures. To overcome these difficulties, the '840 patent proposes using a relatively rigid strip of absorbent material which may be inserted directly through a trocar to a desired operative site. While initially rigid, the absorptive material softens when exposed to blood and other body fluids at the operative site. Optionally, a rigid delivery tube and rod assembly can be utilized to facilitate pushing the absorptive strip through the trocar.
The approach of the '840 patent suffers from certain drawbacks. In the first place, the use of a rigid rod limits the length of packing material that can be introduced through the trocar. Thus, it may be necessary to introduce two, three, or more individual strips in order to provide a sufficient mass of the absorptive material in a particular situation. Second, the positioning and manipulation of the rigid strips can be difficult. This is particularly true when multiple strips are necessary to provide a desired amount of absorptive material. Third, introduction of the rigid strips of absorptive material can sometimes compromise the pressurized seal which is being maintained by the proximal valve on the trocar. This is particularly true when multiple strips of material are to be introduced, although the problem can be ameliorated when using the tube and rod assembly for introducing the absorptive strips.
It would therefore be desirable to provide alternative and improved devices and methods for dispensing surgical packing in laparoscopic and other endoscopic surgical procedures. It would be particularly desirable if the devices and methods could dispense sufficiently long and continuous lengths of packing material so that the packing can usually be accomplished in a single step, i.e., without the need to introduce a plurality of separate packings. The methods and devices should also be easy to use and manipulate, and should provide a relatively tight seal when being introduced through the proximal valve of a trocar.
2. Description of the Background Art
U.S. Pat. No. 5,074,840, is described above. U.S. Pat. No. 2,524,195, describes a gauze packing device having a shaft with a roll of gauze disposed on one side. A push rod within the shaft can be used to advance gauze within the shaft. Other gauze and medical packing applicators are described in U.S. Pat. Nos. 4,895,559; 4,610,659; 1,562,656; 1,537,257; 1,456,828; 716,040; 702,997; 682,090; 654,564; 700,139; and 636,637.